熊艷+江育英+何淑琴+熊玉芳+黃燕+吳小蓮
摘 要 目的:探討早期康復(fù)護(hù)理對(duì)腦梗死患者神經(jīng)功能缺損及日常生活能力的影響。方法:收集2014年8月—2015年1月收治的腦梗死患者60例,隨機(jī)分為試驗(yàn)組和對(duì)照組各30例。對(duì)照組進(jìn)行常規(guī)護(hù)理,包括飲食指導(dǎo)、安全教育等;試驗(yàn)組在對(duì)照組基礎(chǔ)上,為患者制定個(gè)體化的康復(fù)護(hù)理計(jì)劃,進(jìn)行早期康復(fù)訓(xùn)練。觀察患者美國國家衛(wèi)生研究院腦卒中量表(NIHSS)評(píng)分、Barthel指數(shù)、生活質(zhì)量、并發(fā)癥發(fā)生情況。結(jié)果:隨訪6個(gè)月時(shí),試驗(yàn)組NIHSS評(píng)分和Barthel指數(shù)分別為(4.55±0.99)分和50.91±8.55,對(duì)照組分別為(10.24±2.22)分和(7.41±1.04)分,組間差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。干預(yù)后試驗(yàn)組生活質(zhì)量高于對(duì)照組(P<0.05),并發(fā)癥總發(fā)生率為13.33%(4/30),低于對(duì)照組的43.33%(13/30,P<0.05)。結(jié)論:早期康復(fù)護(hù)理對(duì)腦梗死患者神經(jīng)功能缺損及日常生活能力有積極影響,可改善患者神經(jīng)功能缺損情況,提高患者的日常生活能力。
關(guān)鍵詞 腦梗死 早期康復(fù)護(hù)理 神經(jīng)功能缺損 日常生活能力
中圖分類號(hào):R743.3 文獻(xiàn)標(biāo)志碼:A 文章編號(hào):1006-1533(2016)20-0056-03
Influence of early rehabilitation nursing on neurological deficit and daily life ability of patients with cerebral infarction
XIONG Yan, JIANG Yuying, HE Shuqin, XIONG Yufang, HUANG Yan, WU Xiaolian(Department of Neurosurgery of Peoples Hospital, Yichuan City, Jiangxi 336000, China)
ABSTRACT Objective: To explore the effect of early rehabilitation nursing on neurological deficit and daily life ability of patients with cerebral infarction. Methods: From January 2015 to August 2014, 60 cases of cerebral infarction were collected and randomly divided into an experiment group and a control group with 30 cases each. The control group was cared by the routine nursing, including diet guide and safety education. On the basis of the control group, the individualized rehabilitation nursing plan was made for the patients in the experiment group and the early rehabilitation training was carried on. The stroke scale score of the National Institutes of Health in the United States (NIHSS), Barthel index, quality of life and complication occurrence were observed in the patients. Results: The score of NIHSS and Barthel index of the experiment group were (4.55±0.99) and(50.91±8.55) points, respectively, and those of the control group were (10.24±2.22) and (7.41±1.04) points, respectively, and the difference between the groups was statistically significant(P<0.05). The quality of life of the experiment group were higher than that of the control group(P<0.05). The total rate of complication of the experiment group were 13.33%(4/30) lower than that of the control group 43.33%(13/30), (P<0.05). Conclusion: Early rehabilitation nursing has positive effect on neurological deficit and daily living ability of patients with cerebral infarction, and can improve the patients neurological deficit and daily life ability.
KEY WORDS cerebral infarction; early rehabilitation nursing; neurological deficit; daily life ability
急性腦血管病的發(fā)病率在不斷增加,且以急性腦梗死發(fā)病率最高,患者在急性發(fā)病后,常有不同程度的后遺癥,以神經(jīng)功能缺損為主要表現(xiàn),嚴(yán)重影響患者的生活質(zhì)量[1]。對(duì)患者進(jìn)行適當(dāng)?shù)淖o(hù)理干預(yù),可提高患者的生活質(zhì)量,有重要意義。本文報(bào)道我院對(duì)腦梗死患者開展早期康復(fù)護(hù)理的效果。
1 資料與方法
1.1 一般資料
選取我院2014年8月—2015年1月收治的腦梗死患者60例,按入院順序隨機(jī)分為試驗(yàn)組和對(duì)照組各30例。試驗(yàn)組男20例,女10例,年齡49~77歲,平均(65.48±8.77)歲;對(duì)照組男19例,女11例,年齡50~76歲,平均(66.47±8.58)歲。兩組患者的的一般臨床資料差異無統(tǒng)計(jì)學(xué)意義(P>0.05)?;颊呔炇鹬橥鈪f(xié)議書。排除昏迷、嚴(yán)重癡呆、精神疾病患者。
1.2 方法
兩組患者均進(jìn)行常規(guī)治療,改善水、電解質(zhì)平衡等。對(duì)照組進(jìn)行常規(guī)護(hù)理,包括飲食指導(dǎo)、安全教育等。試驗(yàn)組在對(duì)照組基礎(chǔ)上,為患者制定個(gè)體化的康復(fù)護(hù)理計(jì)劃,進(jìn)行早期康復(fù)訓(xùn)練。①良肢位置的擺放:護(hù)理人員要注意患者良肢位置擺放的正確姿勢(shì),為患者取上肢伸展為下肢屈曲位,可減少肢體攣縮變形情況發(fā)生。②言語功能訓(xùn)練:對(duì)于運(yùn)動(dòng)性失語患者,要鼓勵(lì)多說話,多與家人進(jìn)行交流。對(duì)于感覺性失語患者,通過手勢(shì)、表情等,教會(huì)患者不同手勢(shì)的意思。③步行訓(xùn)練:指導(dǎo)患者逐步增加鍛煉難度,并指導(dǎo)家屬進(jìn)行輔助鍛煉。④對(duì)患者進(jìn)行日常生活能力鍛煉,包括洗漱、進(jìn)食、穿衣等,從簡(jiǎn)單到復(fù)雜,逐步得到改善。兩組均隨訪6個(gè)月,觀察患者干預(yù)前后美國國家衛(wèi)生研究院腦卒中量表(NIHSS)NIHSS評(píng)分、Barthel指數(shù)、生活質(zhì)量等。
1.3 評(píng)估標(biāo)準(zhǔn)
NIHSS評(píng)分低于4分為輕度神經(jīng)功能障礙,4~15分為中度神經(jīng)功能障礙,高于15分為重度神經(jīng)功能障礙。Barthel指數(shù)分值滿分為100分,分值越低,患者自理能力越差。生活質(zhì)量采用腦卒中影響量表310(SIS-310)評(píng)估,包括力量、手功能、行動(dòng)能力、日常生活能力、記憶與思維、交流、情感、社會(huì)參與8項(xiàng)內(nèi)容,分值越高,患者生活質(zhì)量越好。
1.4 統(tǒng)計(jì)學(xué)分析
2 結(jié)果
試驗(yàn)組干預(yù)前和隨訪6個(gè)月后的NIHSS評(píng)分分別為(10.37±2.44)分和(4.55±0.99)分,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);對(duì)照組分別為(10.24±2.22)分和(7.41±1.04)分,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。試驗(yàn)組干預(yù)前和隨訪6個(gè)月后的Barthel指數(shù)分別為32.53±7.66和50.91±8.55,對(duì)照組分別為33.25±5.64和45.91±8.77,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。試驗(yàn)組隨訪6個(gè)月后的NIHSS評(píng)分和Barthel指數(shù)均優(yōu)于對(duì)照組(P<0.05)。從表1可見,試驗(yàn)組生活質(zhì)量高于對(duì)照組(P<0.05)。
試驗(yàn)組中,肩痛2例,肌肉萎縮1例,膝關(guān)節(jié)痛1例,總發(fā)生率為13.33%;對(duì)照組中,肩痛5例,肌肉萎縮4例,膝關(guān)節(jié)痛4例,總發(fā)生率43.33%,組間差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。
3 討論
對(duì)患者進(jìn)行早期康復(fù)護(hù)理,可以誘發(fā)來自皮膚、關(guān)節(jié)處深淺感受器的大量信息傳入性活動(dòng),使大腦皮質(zhì)功能得到恢復(fù)重組,利于患者運(yùn)動(dòng)功能的恢復(fù)[2-3]。對(duì)腦梗死偏癱患者進(jìn)行康復(fù)訓(xùn)練,可以減少患者肌肉痙攣的發(fā)生[4]。本研究顯示,出院后6個(gè)月,試驗(yàn)組患者NIHSS評(píng)分低于對(duì)照組和護(hù)理前,Barthel指數(shù)高于對(duì)照組和護(hù)理前(P<0.05)。患者的神經(jīng)功能缺損情況改善較好, Barthel指數(shù)較高。
腦梗死患者進(jìn)行訓(xùn)練往往開始較晚,且功能鍛煉方法不對(duì),發(fā)生肌肉萎縮等的可能較高[5-6]。對(duì)患者進(jìn)行早期康復(fù)訓(xùn)練,可以減少壓瘡、墜積性肺炎的發(fā)生,提高患者生活質(zhì)量。本研究中,試驗(yàn)組生活質(zhì)量高于對(duì)照組(P<0.05),并發(fā)癥總發(fā)生率為13.33%,低于對(duì)照組43.33%(P<0.05),提示早期康復(fù)訓(xùn)練效果較好。
老年急性腦梗死發(fā)病率較高,患者經(jīng)治療后,往往會(huì)留下不同程度的后遺癥[7-8]。傳統(tǒng)的治療方法以搶救患者生命為重點(diǎn)?,F(xiàn)階段,改善患者的生活質(zhì)量越發(fā)引起重視[9-10]。對(duì)患者進(jìn)行早期康復(fù)訓(xùn)練,對(duì)腦梗死患者神經(jīng)功能缺損及日常生活能力有積極影響,能提高患者的肢體運(yùn)動(dòng)功能,降低并發(fā)癥發(fā)生,提高患者的日常生活能力。
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